ASCITES

 

MEANING:

 Ascites is an abnormal accumulation of fluid in the abdomen. Inside the abdomen is a membrane called the peritoneum, which has two layers. One layer lines the abdominal wall and the other layer covers the organs inside the abdominal cavity. The peritoneum produces a fluid that acts as a lubricant and allows the abdominal organs to glide smoothly over one another. Sometimes too much of this fluid can build up between the two layers and this is called ascites. Ascites can occur as a result of a number of conditions, including severe liver disease and the presence of malignant cells within the abdomen. Simply said, Ascites means, an abnormal accumulation of serous fluid in the abdominal cavity.Ascites can also be called as the following names. These include:

* Hydroperitoneum

* Abdominal dropsy

ASCITIC FLUID:

Abdominal paracentesis with analysis of the ascitic fluid should be done in patients with new onset ascites, those requiring hospitalization because of ascites and those whose condition deteriorates during hospitalization.Ascites means, an abnormal accumulation of serous fluid in the abdominal cavity.

The ascitic fluid should be analyzed for:

1.The serum-ascitic albumin gradient (SAAG) is calculated by subtracting the albumim concentration of the ascitic fluid from the albumin concentration of a serum specimen obtained on the same day.

2. The amylase concentration which is elevated in pancreatic ascites.

3. The triglyceride concentration which is elevated is chylous ascites.

4. White cell count when greater than 350/microliter is suggestive of infection. If most cells are polymorphonuclear, bacterial infection should be suspected. When mononuclear cells predominated, tuberculosis or fungal infection is likely.

5. Red cell count when greater than 50.000/microliter denotes hemorrhagic ascites, which usually is due to malignancy, tuberculosis or trauma.

6. Gram stain and culture which can confirm the diagnosis of bacterial infection.

7. PH when less than 7 suggests bacterial infection

8.Cytology can be positive in malignancy.

CAUSES OF ASCITES:

Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).The abdomen becomes very swollen and distended, which can be uncomfortable or painful. It can also cause difficulty in getting comfortable, sitting up or walking. It is a common clinical finding with a wide range of causes, but develops most frequently as a part of the decompensation of previously asymptomatic chronic liver disease.  

Common causes of ascites are as follows:

* If cancer cells have spread to the lining of the abdomen, they can irritate it and cause fluid to build up.

* If the liver is affected by cancer cells, this may block the circulation of blood through the liver, which can lead to a build-up of fluid in the abdomen.

* If the liver is damaged, it may produce less blood protein. This may upset the body’s fluid balance, which causes fluid to build up in the body tissues, including the abdomen.

* Cancer cells can block the lymphatic system. The lymphatic system is a network of fine channels which runs throughout the body. One of its functions is to drain off excess fluid, which is eventually got rid of in the urine. If some of these lymphatic channels are blocked, the system cannot drain efficiently and fluid can build up.Ascites is typically caused by liver disease. These include: 

* Cirrhosis

* Hepatitis

* Portal vein thrombosis (clots in the veins of the liver)

* Constrictive pericarditis

* Congestive heart failure

* Liver cancer

* Ovarian cancer

* Protein-losing enteropathy

* Nephrotic syndrome

* Pancreatitis     

SYMPTOMS OF ASCITES: 

Ascites can be a symptom of many types of cancer. The types of cancer that are more likely to cause ascites are cancer of the breast, lung, large bowel (colon), stomach, pancreas, ovary, and the lining of the womb (endometrium). 

The symptoms of ascites can be very distressing. The abdomen becomes very swollen and distended, which can be uncomfortable or painful. It can also cause difficulty in getting comfortable, sitting up or walking.The following are the common symptoms of ascites.These include:

* Rapid weight gain

* Abdominal discomfort and distention

* Shortness of breath

* Swollen ankles

* Feelings of sickness

* Reduced appetite

* Feelings of sickness (nausea)

* Tired (lethargic)

SIMPLE PREVENTIVE TIPS FOR ASCITES:

Modifying or restricting use of salt can prevent most cases of recurrent ascites.

TREATMENT FOR ASCITES:

Ascites is a disease which is a common clinical finding with a wide range of causes, but develops most frequently as a part of the decompensation of previously asymptomatic chronic liver disease. The treatment of ascites depends on its cause. Treatment may include medicines called diuretics, which help remove the fluid, and antibiotics, if infection develops.

Diuretics:

This may be prescribed if initial treatment is ineffective. The weight and urinary output of patients using diuretics must be carefully monitored for signs of:Hypovolemia (massive loss of blood or fluid)  Azotemia (abnormally high blood levels of nitrogen-bearing materials) Potassium imbalance High sodium concentration. If the patient consumes more salt than the kidneys excrete, increased doses of diuretics should be prescribed.

Large-volume paracentesis:

Large-volume paracentesis is also the preferred treatment for massive ascites. Diuretics are sometimes used to prevent new fluid accumulations, and the procedure may be repeated periodically.

Moderate-to-severe accumulations of fluid are treated by draining large amounts of fluid (large-volume paracentesis) from the patient’s abdomen. This procedure is safer than diuretic therapy. It causes fewer complications and requires a shorter hospital stay.

Spironolactone and furosemide:

 The combination of spironolactone and furosemide is the most effective regimen for rapid diminution of ascites. The starting dose is 100 mg of Spironolactone and 40 mg of Furosemide together in the morning. If there is no decrease in body weight or increase in urinary sodium excretion after two or three days, the doses of both drugs should be increased. The doses of medication can be increased to 400 mg of Spironolactone per day and 160 mg of Furosemide per day.

Dietary tips for ascites:

Diet is quiet effective treatments for ascites.The following foods can be taken by the ascites sufferers.These include:Low-fat yogurt,

*Mackerel,

*Cantaloupe

*Baked potatoes

*Carrot juice,

*Butter milk

*Melon

*Low salt foods  

HERBAL TREATMENT FOR ASCITES:

This is an effective treatment for ascites.This treatment has no side effects. These include:

Kutki(Picrorhiza kurroa):

This is a popular home remedy for ascites.Its beneficial in the treatment of ascites, a disease characterized by the accumulation of fluid in the peritoneal cavity of the abdomen. About 50 grms of the herb is boiled in 200 ml of water till 3/4 of the water has evaporated.

 Punarnava (Boerhaavia diffusa):

The herb is useful in the treatment of ascites, a disease charecterised by accumulation of fluid inside the peritoneal cavity of the abdomen.

Garlic:

Garlic plays a vital role in curing ascites. Half tsp. of garlic juice took in 125 ml. of water cures Ascites. It should be taken regularly for some days.

Mango:

This is a useful home remedy for ascites. Eating mangoes is beneficial in Ascites.The sufferers must eat two mangoes at a time thrice a day.

Gram:

This is also a popular herb for ascites.The ascites sufferers must boil 25 gms. Of gram in ¼ litre of water. When the water is reduced to half the quantity, strain and drinks it. Take it regularly for three weeks.

Onion:

This is also plays an important role in curing ascites. Eating onions frequently proves to be diuretic and is a good medicine for ascites.

Bitter gourd:

This is the most useful home remedy for ascites.The sufferers must take 25 Gms. of bitter gourd juice mixed with water thrice daily provides relief from ascites.

Radish:

The sufferers must take  1/2 cup of the juice of radish leaves mixed with a little water daily is beneficial for patients of ascites.

Fenugreek seeds:

This is the best herb for ascites.The sufferers must take cooked fenugreek seeds or soak them overnight in water, strain and drink it. It is beneficial in ascites.      

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